Reappraisal of the European guidelines on hypertension management. The European Society of Hypertension Task Force document: a short review

The European Society of Hypertension Task Force document on reappraisal of the 2007 European guidelines on hypertension addresses a number of studies published in the last 2 years to estimate their contribution to the expanding knowledge on hypertension. The importance of total cardiovascular risk with inclusion of subclinical cardiac, vascular, and renal organ damage was reemphasized, followed by a critical reappraisal of recommendations for the initiation of antihypertensive drug treatment in patients with high normal blood pressure (BP) and grade 1 hypertension. Whereas there is sufficient evidence for reducing BP below 140/90 mmHg in most hypertensives, the recommendation of previous guidelines to aim at a lower BP in diabetics and in patients at very high cardiovascular risk is not consistently supported by trial evidence. Moreover, the J-curve phenomenon may occur in patients at high cardiovascular risk. With regard to the choice of antihypertensive drugs, the conclusions of the 2007 guidelines that diuretics, angiotensin-converting enzyme inhibitors, calcium antagonists, angiotensin receptor antagonists, and β-blockers are suitable for initiation and maintenance of antihypertensive treatment are reinforced. Furthermore, apart from starting with combination therapy in certain conditions, adding a drug from another class to the initially prescribed one is preferred to increasing the dose of the first one. Some of the drug combinations recommended in 2007 are now regarded as more recommendable. In addition to the benefits of antihypertensive treatment in the elderly, the HYVET (Hypertension in the Very Elderly Trial) has shown that antihypertensive treatment also has benefits in octogenarians. The document ends with a number of issues in urgent need to be approached by new trials.